Breast-milk feeding of very low birth weight infants as a function of hospital demographics

Lee, H C; Gould, Jeffrey B.; Martin-Anderson, Sarah; Dudley, R. Adams

doi:10.1038/jp.2010.179

Cited by 10 publications

(6 citation statements)

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“…Our findings add to the literature documenting that black infants are more likely to receive care in lower quality NICUs (based on higher mortality 21,34,39 and morbidity 23,40 ) and that NICUs with higher proportions of black infants often exhibit lower quality measures (based on lower breast milk at discharge, 41,42 inadequate nurse staffing, 43 and higher rates of infection 42 ).…”

Section: Discussionsupporting

confidence: 61%

Disparities in Health Care–Associated Infections in the NICU

et al. 2019

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Objectives This study aimed to examine multilevel risk factors for health care–associated infection (HAI) among very low birth weight (VLBW) infants with a focus on race/ethnicity and its association with variation in infection across hospitals. Study Design This is a population-based cohort study of 20,692 VLBW infants born between 2011 and 2015 in the California Perinatal Quality Care Collaborative. Results Risk-adjusted infection rates varied widely across neonatal intensive care units (NICUs), ranging from 0 to 24.6% across 5 years. Although Hispanic infants had higher odds of HAI overall, race/ethnicity did not affect the variation in infection rates. Non-Hispanic black mothers were more likely to receive care in NICUs within the top tertile of infection risk. Yet, among NICUs in this tertile, infants across all races and ethnicities suffered similar high rates of infection. Conclusion Hispanic infants had higher odds of infection. We found significant variation in infection across NICUs, even after accounting for factors usually associated with infection.

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Section: Discussionsupporting

confidence: 61%

Disparities in Health Care–Associated Infections in the NICU

et al. 2019

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“…These findings reflect multiple mechanisms that create overall disparity. First, minority infants may be more likely to receive care in poor quality NICUs [ 1 – 7 ]. Very low birth weight (VLBW) infants born in high-black concentration hospitals have higher rates of infection, discharge without breast milk, and nurse understaffing [ 3 ] and these structural barriers likely translate to higher risk-adjusted VLBW infant mortality and morbidity rates [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Disparities in NICU quality of care: a qualitative study of family and clinician accounts

Morton²,

et al. 2018

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ObjectiveTo identify how family advocates and clinicians describe disparities in NICU quality of care in narrative accounts.Study designQualitative analysis of a survey requesting disparity stories at the 2016 VON Quality Congress. Accounts (324) were from a sample of RNs (n = 114, 35%), MDs (n = 109, 34%), NNPs (n = 55, 17%), RN other (n = 4, 1%), clinical other (n = 25, 7%), family advocates (n = 16, 5%), and unspecified (n = 1, <1%).ResultsAccounts (324) addressed non-exclusive disparities: 151 (47%) language; 97 (30%) culture or ethnicity; 72 (22%) race; 41 (13%) SES; 28 (8%) drug use; 18 (5%) immigration status or nationality; 16 (4%) sexual orientation or family status; 14 (4%) gender; 10 (3%) disability. We identified three types of disparate care: neglectful care 85 (26%), judgmental care 85 (26%), or systemic barriers to care 139 (44%).ConclusionsNearly all accounts described differential care toward families, suggesting the lack of equitable family-centered care.

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“…The theme of worse care in minorityserving hospitals recurs throughout this review. * Although these findings could be secondary to other confounders such as socioeconomic differences in influencing disparate outcomes, [39][40][41][42][43]45,46 we also found racial and/or ethnic disparities across processes 9,21,22,24,[27][28][29][30][31]33,37 that disadvantage infants of color. This indicates that disparities may be under the control of providers and amenable to improvement by using available QI tools.…”

Section: Discussionmentioning

confidence: 70%

Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review

et al. 2019

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CONTEXT: Racial and ethnic disparities in health outcomes of newborns requiring care in the NICU setting have been reported. The contribution of NICU care to disparities in outcomes is unclear. OBJECTIVE: To conduct a systematic review of the literature documenting racial/ethnic disparities in quality of care for infants in the NICU setting. DATA SOURCES: Medline/PubMed, Scopus, Cumulative Index of Nursing and Allied Health, and Web of Science were searched until March 6, 2018, by using search queries organized around the following key concepts: “neonatal intensive care units,” “racial or ethnic disparities,” and “quality of care.” STUDY SELECTION: English language articles up to March 6, 2018, that were focused on racial and/or ethnic differences in the quality of NICU care were selected. DATA EXTRACTION: Two authors independently assessed eligibility, extracted data, and cross-checked results, with disagreements resolved by consensus. Information extracted focused on racial and/or ethnic disparities in quality of care and potential mechanism(s) for disparities. RESULTS: Initial search yielded 566 records, 470 of which were unique citations. Title and abstract review resulted in 382 records. Appraisal of the full text of the remaining 88 records, along with the addition of 5 citations from expert consult or review of bibliographies, resulted in 41 articles being included. LIMITATIONS: Quantitative meta-analysis was not possible because of study heterogeneity. CONCLUSIONS: Overall, this systematic review revealed complex racial and/or ethnic disparities in structure, process, and outcome measures, most often disadvantaging infants of color, especially African American infants. There are some exceptions to this pattern and each area merits its own analysis and discussion.

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Breast-milk feeding of very low birth weight infants as a function of hospital demographics

Cited by 10 publications

References 0 publications

Disparities in Health Care–Associated Infections in the NICU

Disparities in Health Care–Associated Infections in the NICU

Disparities in NICU quality of care: a qualitative study of family and clinician accounts

Racial/Ethnic Disparities in Neonatal Intensive Care: A Systematic Review

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